Dr Victoria Seb Khing, MBBS, FIPM
Dimapur,Nagaland.
….I write this article here about the basic facts of Palliative medicine owing to the awareness of the need of it here in our State where the number of terminally ill patients are in the rise. I have come across many patients where the issue of ‘curing’ had run out and no other option was left to them than to go home and suffer in silence since ‘nothing’ more could be done to prevent the disease in progressing. There was a time when a young father hailing from village was diagnosed with cancer only when it had progressed to advanced stage. With no Oncologist in the State, he was advised to go out for further management but they refused due to financial crisis.So they opted to go home in that condition as they did not know what else to do or where to seek the least help they could…….. That’s when I decided to take up this branch of Medicine to extend a hand to add life to the days and not merely adding days to life of the people with life-threatening terminal illness. I also write this to bring about an understanding of the term ‘Palliative Care’ among our people.
Palliative care is the active total care of patients with life-limiting disease, and their families by a multi-professional team when the disease is no longer responsive to curative or life-prolonging treatments.
The WHO defines the goal of Palliative care as the achievement of the best quality of life for patients and their families.
There are various definitions of Palliative care but the core of it all is “total care”. The key aspects include meticulous symptom control, psychosocial and spiritual care.
‘Palliative care’ is derived from the Latin word ‘pallium’ – ‘a cloak’ denoting the way the symptoms are ‘cloaked’ with treatment whose primary aim is to promote comfort. However, as stated earlier, palliative care extends far beyond physical symptom relief; it seeks to integrate Physical, Psychological, Social and Spiritual aspects of care. Palliative care also extends, if necessary, to support in bereavement.
The WHO rightly puts down the facts about Palliative care as:
• provides relief from pain and other distressing symptoms;
• affirms life and regards dying as a normal process;
• intends neither to hasten or postpone death;
• integrates the psychological and spiritual aspects of patient care;
• offers a support system to help patients live as actively as possible until death;
• offers a support system to help the family cope during the patients illness and in their own bereavement;
• uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
• will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life .
The term “palliative care” is increasingly used with regard to diseases other than Cancer such as HIV/AIDS, Rheumatoid arthritis,chronic, progressive pulmonary disorders, Renal diseases, Chronic heart Diseases or progressive Neurological conditions.In addition, the rapidly-growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness.
Palliative care aims to relieve symptoms such as: pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty in sleeping, intolerance to the side-effects of chemotherapeutic drugs or radiation etc.It helps patients gain the strength to carry on with daily life. It improves their ability to tolerate medical treatments. And it helps them better understand their choices for care. Overall, palliative care offers patients the best possible quality of life during their illness. .
There is often confusion between the terms Hospice and Palliative care. In North America, hospice has evolved into a type of time-limited end-of-life care that is not specifically focused around palliative services. Non-hospice palliative care, however, is appropriate for anyone with a serious, complex illness, whether they are expected to recover fully, to live with chronic illness for an extended time, or to experience disease progression
Palliative care is not the same as hospice care. Palliative care may be provided at any time during a person’s illness, even from the time of diagnosis. And, it may be given at the same time as curative treatment.
Hospice care always provides palliative care. However, it is focused on terminally ill patients-people who no longer seek treatments to cure them and who are expected to live for about six months or less. Palliative care today is no longer limited to hospice care, however palliative care began in the hospice movement. Hospices were originally places of rest for travelers in the 4th century CE. In the 19th century a religious order established hospices for the dying in Ireland and London.. The modern hospice is a relatively recent concept that originated and gained momentum in the United Kingdom after the founding of St.Christopher’s Hospice in 1967. It was founded by DameCicely Saunders, widely regarded as the founder of the modern hospice movement.In India, the first hospice was established in Bombay in 1985.
Numerous recent studies confirm earlier observations that dying people and their families experience a wide range of unmet needs, while receiving costly care.This may be because many of us medical practitioners often overlook the basics of ‘total’ care. We often leave the psychosocial issues behind our back ,which may be aggravating or causing the pain as many studies have shown how complying to these needs helps in the overall outcome of the symptom control in these group of chronically ill patients. There is also the issue of illogical prescribing of drugs or insufficient dosage intervals when managing chronic pain. The need of ‘breakthrough’ or ‘rescue’ doses comes into the picture then which can also be given along with other adjuvants.
Palliative care considers the following ethical principles which needs to be applied in the background of respect for life and the acceptance of the ultimate inevitability of death:
1. Respect for patient autonomy
2. Beneficience (do good)
3. Non-maleficience (minimise harm)
4. Justice ( fair use of available resources)
Palliative care benefits both patients and their families. Patient comfort is a main goal. So is support for the family. The team helps patients and family make medical decisions and choose treatments. It also makes sure they get reliable information.
In India, Kerala has the maximum number of Palliative care clinics owing to the wide community participation (NNPC).Witnessing myself how India is slowly but surely emerging into the global network of Palliative care, I believe one day Nagaland will also join hands with the rest of the Nation and the World to actively bring about palliative care to those in need of it!!!!
Any views or comments welcome: drvictoria_222@yahoo.com
